Outcomes Comparison of Venoarterial Extracorporeal Life Support With Acute Decompensated Heart Failure Versus Acute Myocardial Infarction

Acute decompensated heart failure (ADHF) and acute myocardial infarction (AMI) are major etiologies of cardiogenic shock with distinct pathophysiology. This study reported the outcomes of venoarterial extracorporeal life support (V-A ECLS) between ADHF cardiogenic shock (ADHF-CS) and AMI cardiogenic shock (AMI-CS), including 233 patients. Outcomes were compared between patients with ADHF-CS and AMI-CS. Additionally, we classified each study cohort into two groups based on the date of cannulation to V-A ECLS before and after the United Network for Organ Sharing (UNOS) policy change and compared outcomes. There were 107 ADHF-CS patients and 126 AMI-CS patients. A Kaplan-Meier 1 year survival probability of ADHF-CS group was 51.8%, while the AMI-CS group had a 1 year survival probability of 29.2% (p = 0.001). However, the difference in 1 year survival is no longer observed after inverse probability of treatment weighting (IPTW) (37.5% vs. 27.0%, p = 0.28). Regarding myocardial recovery and bridging modality, bridge to recovery or ventricular assist device rate was similar between groups, whereas bridge to transplant rate was significantly higher in the ADHF-CS than AMI-CS after IPTW (3.5% vs. 0.0%, p = 0.010). This trend became particularly evident following the change in the UNOS allocation system.